在学童中使用多点针刺法接种卡介苗：与皮内注射法的比较。
Administration of the BCG vaccination using the multipuncture method in schoolchildren: a comparison with the intradermal method.
作者信息
Al Jarad N, Empey D W, Duckworth G
机构信息
East London TB Service, Bristol Royal Infirmary, UK.
出版信息
Thorax. 1999 Sep;54(9):762-4. doi: 10.1136/thx.54.9.762.
BACKGROUND
BCG vaccination using the multipuncture device (the Heaf gun) is recommended in the UK for infants and very small children only. The aim of this study was to investigate the rate of conversion of the tuberculin test, the safety and acceptability of BCG vaccination using the multipuncture device and to compare it with the conventional intradermal method in schoolchildren.
METHODS
Schoolchildren attending schools in Tower Hamlets who were eligible for BCG vaccination were tuberculin tested using the Heaf gun. Those with grade 0-1 reaction were randomised to receive BCG vaccination using either the multipuncture or the intradermal method. The site of BCG vaccination was inspected after eight weeks for inflammatory changes and scarring. A questionnaire about pain and inflammation at the site of vaccination was completed. The Heaf test was repeated at eight weeks and its results were assessed by an examiner unaware of the results of the previous Heaf test and the method of BCG administration. The Heaf test conversion was deemed to have occurred if there was a change of at least one grade in the response.
RESULTS
One hundred and sixty nine children (83 girls) of mean age 11.8 years completed the study, of which 81 received BCG by the multipuncture method. The Heaf test did not convert in 22 of 81 (27. 2%) receiving BCG by the multipuncture device compared with six of 88 (6.8%) who received the vaccine by the intradermal method (odds ratio 0.2, 95% confidence interval 0.07 to 0.55). The BCG scar was visible in all children who had intradermal BCG compared with 67 of 81 (81.8%) of the multipuncture group. The multipuncture method was less painful and caused fewer inflammatory changes than the intradermal method.
CONCLUSIONS
In schoolchildren the multi-puncture device for administering BCG caused a lower rate of tuberculin conversion as measured by the Heaf test and less of an inflammatory response than the intradermal method. The method needs to be modified before it is applied on a wider scale to schoolchildren.
背景
在英国，仅建议对婴儿和非常小的儿童使用多针刺装置（希夫枪）进行卡介苗接种。本研究的目的是调查结核菌素试验的转化率、使用多针刺装置进行卡介苗接种的安全性和可接受性，并将其与学童中传统的皮内接种方法进行比较。
方法
在塔哈姆雷特就读且符合卡介苗接种条件的学童使用希夫枪进行结核菌素试验。结核菌素试验反应为0-1级的儿童被随机分配接受多针刺或皮内接种卡介苗。八周后检查卡介苗接种部位有无炎症变化和瘢痕形成。完成一份关于接种部位疼痛和炎症的问卷。八周后重复希夫试验，由一名不知道前一次希夫试验结果和卡介苗接种方法的检查人员评估结果。如果反应至少升高一级，则认为发生了希夫试验转化。
结果
169名平均年龄11.8岁的儿童（83名女孩）完成了研究，其中81名通过多针刺法接种卡介苗。在通过多针刺装置接种卡介苗的81名儿童中，有22名（27.2%）的希夫试验未转化，而通过皮内接种法接种疫苗的88名儿童中有6名（6.8%）未转化（比值比0.2，95%置信区间0.07至0.55）。所有接受皮内卡介苗接种的儿童都可见卡介苗瘢痕，而多针刺组81名儿童中有67名（81.8%）可见。与皮内接种法相比，多针刺法引起的疼痛较轻，炎症变化较少。
结论
在学童中，通过希夫试验测量，使用多针刺装置接种卡介苗导致结核菌素转化率低于皮内接种法，且炎症反应也较少。在更广泛地应用于学童之前，该方法需要改进。
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